My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
22293
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
S
>
SHIMIZU
>
3131
>
4200/4300 - Liquid Waste/Water Well Permits
>
22293
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/9/2019 10:08:55 PM
Creation date
12/1/2017 9:07:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
22293
STREET_NUMBER
3131
STREET_NAME
SHIMIZU
STREET_TYPE
DR
City
STOCKTON
APN
13306001
SITE_LOCATION
3131 SHIMIZU DR
RECEIVED_DATE
9/12/67
P_LOCATION
CITY OF STOCKTON
Supplemental fields
FilePath
\MIGRATIONS\S\SHIMIZU\3131\22293.PDF
QuestysFileName
22293
QuestysRecordID
1923290
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
T FOR OFFICE USE: �/ 1 <br /> - - - -------- ---- - <br /> APPLICATION FOR SANITATION PERMIT . . Permit No. .. a �r <br /> (Complete-in Duplicate) / .. .' .----------------� <br />----_---- -----_ ----- _----.-_-_______-._.. This Permit Expires 1 Year From Date Issued Data Issued _ -•-- <br /> Application is hereby made to the San Joaquin local Heal District for a permitto construct and install the work herein described. <br /> This_appliication.is-made•in,com-pliance wit ounty Or - a e o- 549. /33 —040 -©1 <br /> JOB ADDRESS AN Q TION -- _ ' `v'�-J--/ . <br /> ---------------------------------- <br /> ------------ <br /> Owner's Name- ------ ---------- ---- - <br /> f --GI�Cf_-------- ----- ----- <br /> Address-------------------- d, r_ <br /> Contractor's Name----- -------•------- ---== - ----- Phone 1f! <br /> �k-1 7 - <br /> Installation will serve: Residence F1 ./Apartment House ElCommercial ❑ Trailer Courfi ❑ Motel ❑ Other (rf'L4� <br /> Number of living units: ._,___"-Number of bedrooms -------- Number of baths--------- Lot size _ r I <br /> x ;4.. 1 <br /> Wafer Supply: Public;•system A.i Community system [] Private ❑ Depth to Water Table ;_�t „ <br /> Character of soil to a..depth"of 3 feet•_.Sand Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe C] 171 <br /> Hardpan C] <br /> Previous Application Made: {It yes,_date-----{ ..-_-.... ) NoV New Construction: Yes ❑ No FHA/VA: Yes E] N <br /> a.TYPE OF INSTALLATION AND SPECIFICATIONS: �. f <br /> (No septic tank or cesspool permitted if public sewer-is ` <br /> 's available within 200 feet. <br /> Septic Tank: Distance from nearest well________________ Dis t�ante' from foundation- :.___.-,Material ---------------------------------------------- 4. <br /> ❑&S�JA)G No. of compartments-`_',-`----- - -•-----------Size-------------------- -----------Liquid de.pth--------- -- ---- ------ Capacity--------,----0 <br /> Disposal Field: Distance from nearest well-,300".-._Distance from foundation-_3_.�____--_-Distance to nearest lot line__ Q-__--___- <br /> Number of lines._ ��.� ...._Length of each line_ -1L9Q --_rt----Width of trench_-_-_��:l_-------------�- <br /> Type of filter material. ._ _ _Depth of filter material--- -------_._Total length____ �_� <br /> -_ -Q-________.__ <br /> __ .- ------- -, <br /> Seepage Pit: Distance to nearest well...........-----------Distance from foundation-------------------Distance to nearest lot line__-____-_______kI. " <br /> El Number of pits--- --- .......Lining material-------- m - <br /> ------- - - Size: Diaeter-----------------------Depth-------- ---------------------t- <br /> Cesspool: Distance from nearest well ________________Distance from foundation------------- --- ..Lining material_-..------------------------------ <br /> ❑ Size: Diameter- ------ ----------- - --Depth---- ---------------------- --------- --------------Liquid Capacity-------------- ------ 9als.':. <br /> Privy: Distance from nearest well_______ -----------------------------------Distance from nearest building_.---------------------------------_-_--- �I <br /> ❑ Distance to nearest Iodine------------------ - <br /> Remodeling and/or repairing (describe):----- <br /> , - <br /> ------------•------------•-------------------------------- ------------- ---------------------------------------------------- ------- ----------- _ <br /> ------------------- --------------------- _ - ------------------ ----- --------------------------------------- ' ----------- --------------------------------------- ------ <br /> t> <br /> --- ----------------- ------------------- ---------------------------------- ---------------------------------------------------------------' -------------------------------------r--------------------------- <br /> I hereby certify that I have pre ed this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules nd egulations of a San Joaquin Local Health District. <br /> (Signed) ------- / ----gow <br /> ------------- ------------=------ --- ----- wner r Contract <br /> O and/o or <br /> BY ....L `---- -- -- -- ------- -------(Title) ----------- <br /> I (Plot plan, showing size of lot, location of system in relatios, buildings, etc., can.be place n reverse side]. ; <br /> FOR DEPARTMENT USE ONLY <br /> E APPLICATION ACCEPTED BY------- ------------ --------------- DATE...... 3?74 :7a_7------------------------ <br /> REVIEWEDBY----- -------------------------- --- ------ ----"---- - ------------------- --------------------------------------- ----- DATE-- •-- ---------------------------- <br /> PERMITISSUED-------- -- - ------------------------------------------- ------- --_-------------------------- DATE--------------------------- -------------------------------- <br /> Alterationsand/or recommendations------------- - ----------- -------------------- --------- --------------------------------- ------------------- ---- ---------I - ---------•------------- <br /> ---------- ------------------- ---------- ------------------------ --- - ------------------ --- --------- ------------------------------------------ <br /> -------------------------------------•----- --------------------------------- ---- ------------------ ----------------------- --- ------------ --------------- <br /> r <br /> ------------ - --- ----------- - - ----------------- ----------------- ------------------------ <br /> 1 Z <br /> �`.� r} ----- - ---------- Date-.-. /. <br /> FINAL INSPECTION BY:- ------ ----------- ---`-�.,' - --- - -- - - -- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E-H.9 2M 1-67 Vanguard Press _ <br />
The URL can be used to link to this page
Your browser does not support the video tag.